NPWT IN THE COMMUNITY
P
rovision of wound care makes up
a large proportion of community
nursing time (around 70%)
(Drew, 2007), as well as accounting
for 4% of total healthcare expenditure
(Posnett et al, 2009). The Government
strategy to move more care into the
community (Department of Health
[DH], 2009), has also led to increasingly
complex wound management being
provided in patients’homes.
The use of advanced therapies
to promote wound healing is
increasing (Falanga, 2005). Indeed, the
development of such products was one
of the drivers behind the DH’s proposal
that more complex wound care should
be undertaken in the community
setting (DH, 2009). However, it is
essential that nurses who treat wounds
choose the most appropriate product —
balancing the need to provide optimal
care with increasing demands for cost-
effective treatment.
Negative pressure wound therapy
(NPWT) has the potential to promote
wound healing, alleviate exudate
and odour, and improve quality of
life (Wounds UK, 2008).While it was
seen as being an expensive treatment
modality, used in secondary care by
specialists (Ousey and Milne, 2009),
Jeanette Milne, tissue viability nurse specialist,
South Tyneside Foundation Trust
the introduction of more portable and
affordable systems has made it more
accessible to patients in the community
(Dowsett et al, 2012) .
NPWT is commonly used to treat
chronic wounds — category 3 and 4
pressure ulcers, surgical wounds healing
by secondary intention, diabetic foot
ulcers (DFUs) (Chadwick et al, 2009), or
venous leg ulcers in conjunction with
compression — especially those that
have been non-respondent to alternative
therapies. It can be used with different
clinical goals in mind; either as a bridge
to surgical closure or to achieve wound
closure by reducing wound dimensions
and improving the quality and speed of
deposition of granulation tissue.
This article provides practical
guidance on when and how to
successfully use disposable NPWT in the
community setting.
TREATMENT PATHWAYS
The benefits of a formalised care
pathway approach are that it:
`
Introduces a standard of care that
facilitates staff training
`
Improves communication between
organisations and staff
`
Facilitates audit/outcomes tracking
`
Reduces variation in practice
`
Can lead to improvements in
patient experience.
Using disposable negative pressure
wound therapy in the community
IN BRIEF
Wound care represents a large part of the community nurse’s role.
Recently, negative pressure wound therapy (NPWT) devices have
become more portable, facilitating earlier hospital discharge and
increased home use.
Wound measurement is a method of giving patients feedback
RQ FOLQLFDO SURJUHVV DV ZHOO DV GHWHUPLQLQJ WKH HIÀFDF\ RI WKH
treatment chosen.
Patients should be fully involved and informed about their therapy.
KEY WORDS:
Treatment pathway
Portable NPWT
Wound measurement
Outcomes
Jeanette Milne
Care pathways can also be used to
support the rationale for use, duration
of use and patient selection criteria
when justifying a therapy to the funding
authorities in a business case.
To ensure the greatest chance of
success, it is essential that nurses using
NPWT adhere to the manufacturer’s
indications, contraindications and
precautions (
Table 1
). A typical treatment
pathway is shown in
Figure 1
, but it
is also important to bear in mind the
following when considering NPWT.
Choosing the right filler
Both foam and gauze fillers/dressings
are available for use with NPWT.
Table 2
shows their positive and
negative properties.
Level of negative pressure
It has been found that -80mmHg is the
appropriate level of negative pressure
in most wound types and has optimum
effects on (Malmsjö et al, 2009):
`
Microvascular blood flow
`
Wound contraction
10
JCN supplement
2015,Vol 29, No 5
i
Remember
NPWT should not be considered as a
substitute for thorough debridement
and is contraindicated in wounds
containing necrotic tissue.